Dyslipidaemia appears to be prevalent among adolescents and young men in Singapore, including those without traditional metabolic risk factors, according to local research.
In a retrospective cohort of males aged 16–25 years who underwent pre-enlistment medical screening, 13.1 percent were found to have dyslipidaemia. Severe hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] ≥190 mg/dL) was identified in 0.6 percent, while severe hypertriglyceridemia (defined as triglyceride ≥500 mg/dL) was found in 0.2 percent. [J Clin Lipidol 2026;doi:10.1016/j.jacl.2026.04.032]
Looking at lipid parameters, 2.3 percent of participants had total cholesterol levels of ≥240 mg/dL, 2.4 percent had LDL-C levels of ≥160 mg/dL, 5.1 percent had high-density lipoprotein cholesterol (HDL-C) levels of <40 mg/dL, and 7.7 percent had triglyceride levels of ≥200 mg/dL.
“Adult thresholds were applied to all participants rather than using paediatric criteria for those under 20 years. This approach was based on evidence that, by late adolescence, lipid levels and cardiovascular risk trajectories increasingly resemble those of adults, making adult thresholds more clinically relevant,” the authors noted. [Pediatrics 2011;128:S213-S256]
In a sensitivity analysis in which paediatric thresholds were applied in the subset of older adolescents, 35.5 percent met the criteria for dyslipidaemia.
“The high prevalence observed is comparable to that reported in previous studies of adolescents and young adults and portends future cardiovascular risk. These findings challenge the perception that dyslipidaemia is predominantly a condition of older adults,” they added. [JAMA 2023;330:261-274; Lipids Health Dis 2023;22:108]
Factors associated with dyslipidaemia
“Hypercholesterolemia and hypertriglyceridemia were associated with different factors,” the authors said.
In the cohort, hypercholesterolemia was primarily associated with age (adjusted odds ratio [aOR], 1.19, 95 percent confidence interval [CI], 1.11–1.28; p<0.001), whereas hypertriglyceridemia was more strongly associated with metabolic factors such as overweight (aOR, 1.48, 95 percent CI, 1.26–1.73; p<0.001) and obesity (aOR, 2.50, 95 percent CI, 2.02–3.09; p<0.001).
Higher body fat percentage was associated with increased odds of hypercholesterolemia (aOR, 1.05, 95 percent CI, 1.04–1.06; p<0.001) and hypertriglyceridemia (aOR, 1.04, 95 percent CI, 1.03–1.05; p<0.001), which the authors noted to be consistent with the established role of adiposity in lipid metabolism dysregulation. [Nutrients 2023;15:3968]
“Notably, however, 58.6 percent of participants with dyslipidaemia in our cohort had no obesity, and 7.4 percent of participants who were underweight or within the normal weight range had dyslipidaemia,” the authors pointed out.
“These observations suggest that reliance on traditional indicators of metabolic disorders for targeted screening may overlook a substantial portion of individuals with underlying dyslipidaemia, and that universal lipid screening in this age group can potentially facilitate early detection and optimization of control,” they added.
An under-recognized condition
In light of the present data, the authors pointed out that dyslipidaemia in older adolescent and young adult males may be under-recognized, especially in those without conventional metabolic risk factors in whom routine testing is not conducted.
“Broader inclusion of younger populations in epidemiological studies, along with cost-effectiveness analyses of different screening strategies, will be essential to inform evidence-based policy and optimize resource allocation,” they said.
The analysis included 19,130 males aged 16–25 years (median 18 years, 67.3 percent Chinese). The median BMI was 22.3 kg/m2, with 25.9 percent having overweight and 18.4 percent having obesity.